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At least 667 records · Page 37Linked to original sources
PubMed2005

Internal fixation for displaced fractures of the femoral neck. Does bone density affect clinical outcome?

The results of meta-analysis show a revision rate of 33% for internal fixation of displaced fractures of the femoral neck, mostly because of nonunion. Osteopenia and osteoporosis are highly prevalent in elderly patients. Bone density has been shown to correlate with the intrinsic stability of the fixation of the fracture in cadaver and retrospective studies. We aimed to confirm or refute this finding in a clinical setting. We performed a prospective, multicentre study of 111 active patients over 60 years of age with a displaced fracture of the femoral neck which was eligible for internal fixation. The bone density of the femoral neck was measured pre-operatively by dual-energy x-ray absorptiometry (DEXA). The patients were divided into two groups namely, those with osteopenia (66%, mean T-score -1.6) and those with osteoporosis (34%, mean T-score -3.0). Age (p = 0.47), gender (p = 0.67), delay to surgery (p = 0.07), the angle of the fracture (p = 0.33) and the type of implant (p = 0.48) were similar in both groups. Revision to arthroplasty was performed in 41% of osteopenic and 42% of osteoporotic patients (p = 0.87). Morbidity (p = 0.60) and mortality were similar in both groups (p = 0.65). Our findings show that the clinical outcome of internal fixation for displaced fractures of the femoral neck does not depend on bone density and that pre-operative DEXA is not useful.

Absorptiometry, Photon↗
PubMed1993

Prevalence of vertebral fracture in women and the relationship with bone density and symptoms: the Chingford Study.

A population survey was performed to estimate the prevalence of vertebral fractures in women aged 45-69 and to determine their relationship to bone density and symptoms. Subjects were 1035 women aged 45-69 (mean 55.4 years, response rate 77%) from the age-sex register of a large 11,000-person general practice in Chingford, London. Thoracic and lumbar spine x-rays were read by a semiautomated quantitative method. Vertebral fractures were diagnosed using a variety of morphometric methods, including a new method we recently developed and the published methods of Melton and Eastell. These methods all detect abnormal ratios between anterior, central, or posterior vertebral height and between observed posterior vertebral height and values predicted from the posterior height of adjacent vertebrae. Bone mineral density (BMD) of lumbar spine L1-4 and neck of femur was measured by dual-energy x-ray absorptiometry (DXA). Using our method, 147, 14.2% (95% CI 12.0-16.2%) of the 1035 women, had minor fractures (at least two vertebral ratios 2-2.99 SD below the mean) and 20, 1.9% (95% CI 1.2-3.0%) of the total, had severe fractures (at least two ratios more than 3 SD below the mean). In the 147 women with minor fractures, bone density of the spine was not significantly lower than in the other 868 women, and reported back pain or loss of height was no more common. Women with multiple minor fractures did have lower bone density, by 0.4 SD. In the 20 women with severe fracture, bone density was significantly lower, by 0.6 SD.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMedDate not supplied

The correlation of serum ferritin level to Ca-P metabolism and bone density study in thalassemic patients.

A study of Ca-P related hormones and bone densities was carried out in seven homozygous beta-thalassemia patients. The levels of Ca, P, and Ca-P related hormones were not significantly changed except for 1,25(OH)2D3 which was significantly lower than in the control group and was inversely related to patients' ferritin levels. Bone densities were markedly reduced in all the thalassemic patients.

Adolescent↗
PubMed1999

Effect of physical training and its cessation on percent fat and bone density of children with obesity.

OBJECTIVE: We determined the effect of 4-month periods of physical training (PT) and detraining on percent fat (percent fat) and bone density of children with obesity. RESEARCH METHODS AND PROCEDURES: Subjects were 79 7- to 11-year-old children with obesity; 34 were white, 44 were black, and 1 was Asian, 26 were male and 53 were female. They were randomly assigned to two groups: group 1 engaged in PT for the first 4 months, while group 2 engaged in PT during the second 4 months. Body composition was measured with dual energy absorptiometry, and diet was measured with 4 days of recall for each 4-month period. PT was offered 5 days/week for 40 minutes/session, heart rate monitors were worn, and no dietary information was given; mean attendance was 80%, and mean heart rate per session was 157 bpm. RESULTS: Group by time interactions across the three time-points (from analysis of variance) were significant for percent fat (p = <0.001) and bone density (p = 0.045). Both groups declined in percent fat during the periods of PT, by an average of 1.6% fat units; in the 4 months after cessation of PT, group 1 increased by 1.3% fat. In both groups, bone density increased more during periods of PT (0.025 g/cm2) than during periods of no PT (0.010 g/cm2). No significant PT vs. no-PT differences were found for dietary intake of energy, macronutrients, or calcium. DISCUSSION: This study suggests that regular exercise, without dietary intervention, can enhance the body composition of children with obesity.

Adipose Tissue↗
PubMed2006

Premenopausal women and low bone density.

OBJECTIVE: To review the evidence and provide an approach to management of low bone density among premenopausal women. QUALITY OF EVIDENCE MEDLINE: was searched from January 1990 to November 2004 and articles graded by level of evidence (I to III). Diagnosis and management recommendations were based on evidence from randomized controlled trials and expert consensus. MAIN MESSAGE: Bone mineral density (BMD) testing among premenopausal women should be completed only in the presence of approved indications. Current evidence does not support screening for osteoporosis among premenopausal women. Low BMD in premenopausal women is associated with a lower fracture risk than seen in postmenopausal women. In the absence of fragility fractures, low BMD might reflect low peak bone mass based on genetic predisposition, environment, and lifestyle factors. Clinical evaluation enables distinction between low peak bone mass and a systemic disorder resulting in low BMD and skeletal fragility. Common causes of low bone density among premenopausal women include ovulatory disturbances and low body weight. CONCLUSION: Bone mineral density alone is insufficient for diagnosis of osteoporosis among premenopausal women in the absence of fragility fractures. Antiresorptive therapy has been evaluated and shown to benefit premenopausal women using glucocorticoid therapy or those with primary hyperparathyroidism.

Bone Resorption↗
PubMed2006

Steroids and bone density in patients with functioning kidney allografts.

INTRODUCTION: Osteopenia and osteoporosis after renal transplantation have been associated with factors related to the cause of end-stage renal disease, as well as to clinical events and therapeutic factors in the posttransplant period. We studied the prevalence of low bone density (LBD) according to WHO criteria. METHODS: A cross-sectional study was performed in a cohort of 106 patients (54 men and 52 women) with functioning renal allografts, who underwent bone densitometry (DEXA) of the lumbar spine and femoral neck. Patients were grouped according to DEXA into those with normal bone density (NBD) or LBD. We studied clinical, analytical, and therapeutic variables. RESULTS: Thirtysix patients (34%) had NBD and 70 patients (66%) LBD. Weight was the only parameter showing a significant difference (P = .034), namely, among NBD it was 80.44+/-15.13 versus LBD 73.94 +/- 14.54 kg, respectively. Creatinine clearance (CCr) tended to be lower among patients with LBD 59.62 +/- 22.73 versus 69.59 +/- 28.15 mL/min in patients with NBD (P = .052). PTHi levels were higher in patients with LBD (149.39 +/- 110.75) than those with NBD (110.94 +/- 82.61) (P = .069). In the multivariate analysis the important determinants were weight Exp(ss) = 0.967 [CI = 0.939 to 0.996] (P = .036); CCr Exp(ss) = 0.982 [CI = 0.965 to 1.000] (P = .055); and PTHi levels Exp(ss) = 1.003 [CI = 0.932 to 0.994] (P = .059). CONCLUSIONS: Osteopenia and osteoporosis are frequent among kidney transplant patients (66%), with a similar distribution between the lumbar spine and femoral neck. Excess weight and possibly better renal function may be protective factors. The cumulative steroid dose showed a significant effect on bone density. As expected, secondary hyperparathyroidism in patients with renal impairment seemed to be a risk factor for LBD.

Absorptiometry, Photon↗
PubMed1993

Passive motion: the dose effects on joint stiffness, muscle mass, bone density, and regional swelling. A study in an experimental model following intra-articular injury.

We studied the effects of passive motion on joint stiffness, muscle mass, bone density, and regional swelling after an intra-articular injury. Instrumentation was applied to the hindlimbs of thirty adolescent New Zealand White rabbits to allow either passive motion or immobilization of the ankle. The knee was immobilized by the locking together of Steinmann pins that had been placed within the medullary canals of the tibia and femur. An intra-articular injury was produced by drilling of the tibial pin through the ankle joint into the talus and subsequent withdrawal of the pin from the ankle joint. The rabbits were divided into five groups, and they received four, eight, twelve, sixteen, or twenty-four hours of passive motion each day during the three-week period of study. One ankle of each rabbit was moved through an arc of 90 to 170 degrees of dorsiflexion at one cycle per minute, while the contralateral ankle was immobilized in 100 degrees of dorsiflexion with an aluminum splint, which was fixed to the aluminum block that was used to stabilize the knee joint. We found that sixteen and twenty-four hours of passive motion prevented stiffness of the joint. Passive motion for shorter periods was ineffective, even harmful, and resulted in stiffness ratios that were as much as four times higher than those of the control limbs (those treated with immobilization). Swelling of the limb decreased only in the group that received twenty-four hours of passive motion. Muscle mass increased by an average of 13 per cent (range, 4 to 34 per cent), in comparison with that of the immobilized limbs in every group that was treated with passive motion. Bone density was maintained only in the limbs in which the ankle became stiff (ankles that had been treated with passive motion for twelve hours or less). An inverse relationship was noted between the duration of passive motion and the radiographic density of the distal tibial metaphysis; this relationship was statistically significant (p < 0.01). The limbs treated for twelve, eight, or four hours each day showed progressively greater bone density in comparison with those treated with immobilization or with sixteen or twenty-four hours of passive motion.

Animals↗
PubMed2000

[Durability of open bite treatment on the basis of bone density examination and evaluation of clinical status].

The aim of this work was to evaluate the results of open bite treatment with vertical elastic traction and extrusion arches, taking into account bone density and clinical findings. Bone density was assessed on Digora radiographs and on panoramic radiographs before and after treatment. Attention was also focused on side effects. The investigation was carried out in 37 patients (31 women and 6 men) with partial open bite. Patients aged 12-18 years were assigned to group I, older than 18 years to group II. Fixed appliances were attached to the upper and lower arches with vertical elastic traction. 158 radiographs of jaw bones were analyzed with the Digora computer system. Two panoramic radiographs were made in each patient. In addition, 84 Digora radiographs of upper and lower incisors were obtained in randomly selected patients. Successful correction of open bite was achieved in all patients. Mean slit size before treatment in I group was 3.2 mm. Treatment resulted in an overbite of 1.8 mm. Mean duration of treatment was 5.5 months. In group II, mean values before treatment were lower and mean duration of treatment longer. Comparison of radiographs of the incisors obtained before and after treatment revealed only very limited changes in bone structure.

Adolescent↗
PubMed2001

Changes in bone density after cemented total knee arthroplasty: influence of stem design.

Total knee arthroplasty has shown excellent survivorship in short-term and intermediate-term studies. With longer follow-up, however, aseptic loosening becomes an increasing cause of failure. Dual-energy x-ray absorptiometry scanning has shown that stress shielding occurs from altered mechanical loading. The purpose of this study is to determine if tibial stem design affects bone density in the longterm. Bone densities in the proximal tibia with and without cemented stems were compared at an average of 94 months after surgery. The bone quality under the Miller-Galante I prosthesis, which has 4 0.5-cm pegs, was compared with the bone quality under a Press-Fit Condylar prosthesis with a single 4-cm stem. Each group was also compared with the unoperated contralateral tibia. Results showed that there is a significantly reduced density of bone in the tibial metaphysis in the cemented stemmed group but not in the pegged group. There were no changes distally in the diaphyseal bone. This study supports the contention that the use of a cemented stem reduces proximal stresses and may result in proximal bone resorption. Although the use of a stem provides excellent resistance to lift-off and shear, it comes at a price. The proximal resorption may contribute to the persistence of tibial component loosening as a primary threat to survivorship. This bone loss may complicate revision surgery. Consideration should be given to using shorter tibial stems, less cement, or alternative designs that avoid long-stem fixation.

Absorptiometry, Photon↗
PubMed2001

Bone density, dynamic joint loading and joint degeneration. A review.

Increased joint loading and elevated bone density may be involved in the initiation or progression of osteoarthritis. Here, we provide an introduction to the literature on this topic and describe recent studies from our laboratories on several cohorts of subjects who had or were scheduled to have a total hip replacement for unilateral end-stage osteoarthritis. This population is very useful for studying the development and progression of osteoarthritis because of the known higher incidence of osteoarthritis in the contralateral hip than in a normal population. Separate studies of the asymptomatic contralateral hip in these subjects have shown that radiographic signs of early osteoarthritis are associated with increased bone mineral density and some of the gait adaptations typically found in subjects with end-stage osteoarthritis. We have also shown in separate studies of similar populations that elevated bone mineral density is associated with a subsequent accelerated joint space narrowing rate and that elevated hip joint loads during gait are similarly associated with an accelerated narrowing rate. Major questions yet to be answered are how joint loading and bone density interact in the development and progression of joint degeneration.

Adaptation, Physiological↗
PubMed1996

Bone density changes after 1 year in periodontal lesions treated surgically with or without ePTFE membrane placement.

The present study was designed to quantitatively assess radiographic changes in alveolar bone density in intrabony defects treated with expanded polytetrafluorethylene membranes (ePTFE) or by conventional flap surgery alone. 15 patients with 2 periodontal defects of comparable morphology which could be depicted on a single radiograph made up the test panel. Standardized radiographs of the periodontal defects were taken immediately prior to surgery and 12 months later. The 2 defects were treated simultaneously using the modified Widman flap procedure and prepared for membrane placement. Then one of the lesions was randomly assigned for treatment with the membrane. All radiographs and surgical procedures were managed by one person. The radiographs were assessed by another person according to a blind design. Periodontal defects treated with ePTFE membranes (test), and sites treated by conventional flap procedures (control) were then analyzed using a computerized image analysis program. In 8 patients, the test site outcome was better than the outcome in the control site. 6 of the control sites indicated increased bone density, while 7 sites showed decreased values, and 2 sites were unchanged. The corresponding values from the test sites were 5, 6 and 4, respectively. In the present controlled clinical study, the use of an ePTFE membrane to cover the opening of a vertical bone defects during periodontal surgery did not predictably increase the bone density of the defects.

Alveolar Bone Loss↗
PubMed2003

Alendronate prevents loss of bone density associated with discontinuation of hormone replacement therapy: a randomized controlled trial.

BACKGROUND: Many women using hormone replacement therapy (HRT) will discontinue HRT and lose its bone-protective effect. Methods to preserve bone density in these women need to be explored. This multicenter, international, randomized, blinded, 12-month study was conducted to assess the effect of alendronate sodium on bone density in women who had recently discontinued HRT. METHODS: The 144 postmenopausal women included in the study were diagnosed as having low bone mineral density (BMD) and had recently discontinued HRT. They were randomized to receive either a daily dose of 10 mg of alendronate sodium or matching placebo. The main outcome measures were spine, hip, and total body BMD; biochemical markers of bone turnover; and tolerability. RESULTS: Alendronate treatment was associated with a 2.3% mean increase (95% confidence interval [CI], 1.7%-3.0%) in spine BMD compared with a mean loss of 3.2% (95% CI, - 4.6% to - 1.7%) in patients receiving placebo, for a difference of 5.5% (95% CI, 4.2%-6.8%) between alendronate and placebo. Greater hip and total body BMD preservation was also observed with alendronate use. Bone turnover decreased significantly with alendronate (bone-specific alkaline phosphatase levels decreased by 20% and urinary N-telopeptide/creatinine ratio by 47%), but increased in the placebo group (by 18% and 36%, respectively). Alendronate was well tolerated, with no increase in adverse events compared with placebo. CONCLUSIONS: A high rate of bone loss was observed in the first 12 to 15 months after discontinuation of HRT in postmenopausal women with low BMD. Treatment with alendronate increased or maintained both spine and hip BMD and prevented the increase in bone resorption seen with withdrawal of HRT in this population.

Alendronate↗
PubMedDate not supplied

The use of clinical CT for baseline bone density assessment.

PURPOSE: Many patients having an abnormal initial bone densitometry study have had a previous abdominal/pelvic computed tomography (CT) for other clinical reasons. This study evaluates if a nondedicated quantitative CT (QCT) abdominal/pelvic CT scan could be used as reliable baseline data for subsequent dedicated bone density studies. SUBJECTS AND METHODS: Twenty-six patients (13 men, 13 women) undergoing clinically-indicated non-i.v. and i.v. contrast abdominal/pelvic CT had dedicated QCT performed immediately following scans of the L1, L2, and L3 vertebral bodies. QCT was then performed on all three scans. A repeated measures analysis of variance model was used to analyze the data in order to compare noncontrast clinical CT with QCT and noncontrast clinical with contrast clinical CT. RESULTS: The mean bone mineral density for the noncontrast clinical study was 98.51 (mg/cc) versus 90.56 (mg/cc) for QCT (p = 0.0003; 95% confidence interval: 3.90 to 13.71). There was no significant difference (p = 0.085) between QCT performed from non-i.v. and i.v. contrast clinical CT scans. CONCLUSION: Bone densitometry can be performed from either non-i.v. or i.v. contrast clinical CT scans if a conversion factor is applied. This can be determined by utilizing a formula Daverage = -7.83 + (0.99 x NCaverage), where Daverage and NCaverage are the abbreviations of "dedicated" and "noncontrast clinical" BMD averaged over vertebral bodies L1-L3, respectively.

Adult↗
PubMedDate not supplied

Osteoporosis in childhood: bone density of children in health and disease.

Bone mineral density in later life largely depends on the peak bone mass achieved in adolescence or young adulthood. A reduced bone density is associated with increased fracture risk in adults as well as in children. Pediatricians should therefore play an important role in the early recognition and treatment of childhood osteoporosis. Juvenile idiopathic osteoporosis and osteogenesis imperfecta are examples of primary osteoporosis in childhood. However, osteoporosis is more frequently a complication of a chronic disease or its treatment. This paper provides an overview of bone and bone metabolism in healthy children and the use of diagnostic tools, such as biochemical markers of bone turnover and several bone densitometry techniques. Furthermore, a number of diseases associated with osteoporosis in childhood and possible treatment strategies are discussed.

Biomarkers↗
PubMed1993

The relationship between spinal and peripheral osteoarthritis and bone density measurements.

OBJECTIVE: To determine the influence of osteoarthritis (OA) on bone density measurements and whether OA at one site is associated with OA at other sites. METHODS: Nonrandomized, cross sectional observational study; secondary analysis of a general population database. Sixty-four subjects derived from a longitudinal study of long distance runners and community controls had a complete peripheral radiographic evaluation for osteoarthritic changes in hands, knees, and lumbar spine. Forty-four of these were studied in 1984 with quantitative computed tomography (QCT) of L1, and 54 were studied in 1988 with 153-Gd dual photon absorptiometry (DPA) in the spine and total body. Thirty-four subjects had all measurements done. RESULTS: Total body and lumbar spine DPA were positively correlated with radiological scores of OA in the spine and knees, with coefficients ranging between 0.467 to 0.530 (p < 0.001 in all cases). This correlation was principally associated with spinal spurs and knee sclerosis. Results of stepwise multiple linear regression modeling for QCT included age, spine sclerosis, knee sclerosis and knee spurs as the main predictors of bone mineral density (BMD). For DPA measurements, spine spur score was a useful regressor for all the models. Altogether, the percentage of variance accounted for by individual radiological OA variables was 27.4% for lumbar QCT, 27.3% for lumbar BMD, 7.3% for total spine BMD, and 45.2% for total body BMD. OA scores at different sites were not correlated, although repeated assessment at the same site showed very close correlation. CONCLUSIONS: All methods used to determine BMD showed a highly significant positive correlation between lumbar and knee radiological OA and bone mineral content both in the spine and the total body. Thus, our results support the hypothesis that OA is negatively correlated with osteopenia. OA, as seen in this population, was not a generalized condition, but rather, was site specific.

Aged↗
PubMed2002

The influence of hormonal status and features of the metabolic syndrome on bone density: a population-based study of Swedish women aged 50 to 59 years. The women's health in the Lund area study.

This study investigated whether there is an association between bone density and features of the metabolic syndrome in relation to hormonal status. All women aged 50 to 59 years living in a defined geographic area in Sweden were offered a health assessment program including blood glucose, lipid profile, blood pressure, and bone densitometry. Women were divided into 3 groups according to their hormonal status: premenopausal (PM), postmenopausal with hormone replacement therapy (PMT), and postmenopausal without hormone replacement therapy (PM0). Of the 6,886 women investigated, 7% were PM, 41% PMT, and 52% PM0. The overall prevalence of osteopenia and osteoporosis, according to the World Health Organization (WHO) definition, was 42.6% and 6.6%, respectively. T-score in the PM group was higher than in the PMT (P <.05) and PM0 groups (P <.001) and higher in the PMT group compared with the PM0 group (P <.001). Also, in the total cohort, the bone density was positively associated with body weight, body mass index (BMI), waist-to-hip ratio (WHR), systolic blood pressure (SBP), diastolic blood pressure (DBP), serum triglycerides, and blood glucose (P <.001 for all) and negatively associated with serum levels of cholesterol (P <.05) and high-density lipoprotein (HDL) (P <.001). This was most evident among the PMO women, suggesting that the influence of metabolic factors on bone density increases when the levels of hormones decrease. This indicates that hormone replacement therapy maintains treated women in a premenopausal status concerning the metabolic factors.

Absorptiometry, Photon↗
PubMed2001

A prospective, longitudinal study of the long-term effect of treatment on bone density in children with celiac disease.

OBJECTIVE: Because osteopenia is a frequent complication of celiac disease, we evaluated the impact of a long-term gluten-free diet (GFD), initiated during childhood, on bone density. study design: Patients with celiac disease (n = 19; mean age, 14.2 +/- 2.6 years) were studied after 4.3 +/- 0.6 years of GFD. Bone density had been measured at diagnosis and after 1 year of GFD. We also studied 211 healthy children as a control group. Bone mineral density was measured by dual-energy x-ray absorptiometry. Intact parathyroid hormone (PTH) and bone-specific alkaline phosphatase (BALP) levels were measured in serum, and N-terminal telopeptide of type I collagen (NTx) was measured in urine. RESULTS: Although at diagnosis bone mineral content, bone area, and bone mineral density were significantly lower than in control subjects, the 3 measurements were normal after GFD. None of the patients on a GFD showed elevated values of PTH. Patients on a GFD had BALP (110.2 +/- 67.2 U/L) and NTx levels (261.9 +/- 187.8 nmol bone collagen equivalents/mmol creatinine) that were significantly higher than those of control subjects. The levels of BALP and NTx were significantly higher in patients with good compliance with the GFD, compared with patients with poorer compliance. CONCLUSIONS: This study shows that bone mineral content, bone area, and bone mineral density improve significantly with a GFD.

Absorptiometry, Photon↗